Intractable voiding dysfunction in children with normal spinal imaging: predictors of failed conservative management

To identify the factors that might predict which individuals ultimately fail to resolve voiding symptoms by analyzing their presenting symptoms and video-urodynamic findings. Older children with intractable voiding dysfunction and no evidence of neurologic abnormality, who are recalcitrant to medical treatment, pose a management challenge.

The charts of neurologically normal children with intractable voiding dysfunction, who had fluorourodynamic studies and normal lumbosacral magnetic resonance imaging, were reviewed. A database was created that included the urodynamics, presenting urinary symptoms, presence of soiling or constipation, age at onset of symptoms, cystogram and bladder ultrasound findings, and treatments given. Long-term follow-up was determined from chart review (all patients) or by a mailed survey (15 patients). Patients without symptoms and off medication were defined as normal.

A total of 50 children met the criteria mentioned earlier in the text, presented at a mean age of 9.4 years (range, 3.8-17.3) and were followed up for a mean of 4 years (range, 1-11) from their initial urodynamic evaluation. Of them, 33 (66%) remained symptomatic and 1 (34%) normalized. A total of 31 were found to have uninhibited bladder contractions (UBCs) with daytime wetting, of which 24 (77.4%) failed to normalize (P = .037). All 9 with UBCs and detrusor-sphincter dyssynergia remained symptomatic (P = .02).

The majority failed to resolve their voiding symptoms. Children who presented with daytime wetting, UBC, and detrusor-sphincter dyssynergia were the most likely to remain symptomatic. Patients with these characteristics might be considered for more aggressive alternative therapies, after a period of medical management.